NPI | 1437447984 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 31121) |
Additional Taxonomies | 122300000X Dentist (Licence: OK 6284) |
Enumeration Date | 2011-07-19 |
Last Update Date | 2023-12-12 |